Purposeful conversation

The centrality of knowledge, connection and conversation to staff engagement, job satisfaction and organizational effectiveness has been discussed here over recent weeks. In respect to this concatenation, the three elements are interconnected with one another to the extent that they lock together systemically. In seeking to substantiate this theoretical assertion, one might say, then, that connections appear and flourish through quality conversation; that knowledge can only flow freely where connections exist as channels; and that knowledge is expressed and explored in conversation.

While conversation in and of itself is intrinsic to the act of organizing – and I will be exploring the relationship between organizing and organization in a podcast shortly – the nature of the conversation is patently important. In light of this, I have been using the term “purposeful conversation”, which intimates a sense of purpose and a clarity of focus to these workplace exchanges.

Speaking Together

Now, partly this refers to the quality of that conversation. In this respect, there is something to be said for Nancy Kline and her Time to Think approach. Certainly, she specifies ten elements that are critical to giving people the time to think and to articulate those thoughts in a supportive forum.

For me – and for many practitioners – the three crucial elements are those of ease (that is, being able to think without the sense of urgency that can prevalent and so destructive in the workplace); attention (by which is meant that people are given the space to speak and are actively listened to by those with whom they are working), and equality (meaning that everyone in the room gets air time to give voice to their freshest thinking about an issue).

Certainly, this method generates meetings that are substantially and qualitatively different to the standard corporate formats with which many of us are depressingly familiar. They open up what Kline calls a thinking environment. Conversationally, however, it is not an approach that feels intrinsically dialogic: its dynamic is different to that which one might expect to find in a rich and deep conversation.

That said, at root, the Time to Think method promulgates the notion of genuinely and authentically taking time to listen as well as feeling licence to give voice to your thinking, regardless of whether that thinking might be judged as “complete” or in some sense definitive. And these aspects patently undergird high quality conversation between people as they occur in practice.

However, while it is important to envisage how purposeful conversations might take place, it is equally vital to give thought to what might be the subject of a purposeful conversation. That is not to be prescriptive in this regard: a purposeful conversation is likely to be lively, relevant and focused…and will occur spontaneously in context. (Think of a team discussion informally arising to address a particular and immediate sticking point in respect to their collective practice.)

Colourful Conversation

That said, in the ebb and flow of actions and reactions around organizing, it would doubtless be helpful to have a notion of how best to support conversation that can be purposeful in this way. It is in light of this that I continue to work in order to craft a framework that uses seven elements of organizing to enable this, each of which – individually; in combination, or in the liminal spaces that exist between these aspects – offers interlocutors material to prompt purposeful conversations about their organizing and how it might best take place. The framework is in its third iteration, following an extremely useful critical exploration of this thinking by colleagues in the OD Innovation Network (ODiN).

Elsewhere, I have been enjoying a correspondence with David Gurteen, whose focus is on the vital human importance of conversation in and of itself. While coming from what might be broadly described as a knowledge management background, David is, for me, a humanist who sees conversation as intrinsic to our personal wellbeing and self-development, as well as to the effectiveness of our organizing.

Taking the three questions I spoke about in a recent post here as his starting point, he has built upon these in order to introduce fresh elements. For example, he factors in the rich linkage between passion and responsibility, while also urging people with shared passions to forge relationships, and to think through how those relationships might be sustained.

I am very much enjoying our exchange and the potential that it offers and look forward to it continuing. It strikes me that, even though this is being conducted via email at this time, David and I are enjoying (and hopefully both benefiting from) a purposeful conversation about conversations. The opportunity to contribute to that is open, of course, to everyone who reads this and is moved to make a comment.

Knowledge, Conversation, Connection

I have had great fun working up a paper for publication in a peer-reviewed journal over the past nine or so months, which looks at the challenges around organizational learning and development in our contemporary context.

The key observation of this article is that all work around supporting people to make their organizations better needs to build around three elements:

  1. Opening up channels so that knowledge can flow more freely and hence pool where it is needed;
  2. Encouraging as much connection as possible across the organization (and the wider system in which it sits); and
  3. Facilitating meaningful and impactful conversation between the widest range of people (which, in turn, supports connectivity and the spread of knowledge).

As with all academic publishing, the published paper is a little less than what I wanted to write and a little more of what the reviewers and editors wanted to read…and it is doubtless none the worse for that.

However, I am mindful that the editing process saw two features drop which I still feel useful from the perspective of a practitioner. As a result, I am offering those elements here, supplementary to the main paper.

Our Four Challenges

I started with a consideration of what the four main challenges might be in respect to helping contemporary organizations to work more effectively through engagement with their people. To an extent, these challenges both precede the idea that knowledge, connection and conversation are central to improvement in this regard – and, to an extent, allow a practitioner to think creatively as to how those three elements might be realized in the context of organizations.

Four Challenges

I am of the opinion that these four distinct challenges, expressed in this fashion, offer a reflective space wherein practitioners can consider how best to work on this vital agenda. For example, in regard to Challenge #1, it seems apparent to me on the basis of experience that knowledge resides in practice – and that practice occurs within an organizing context. To think of knowledge resonating in any other setting – in the training room, the classroom or in e-learning – is, to my thinking, problematic and is one of the reasons that so much is spent on “training” with so very little to show for it.

Incidentally, I deliberately use the term organizing in this respect rather than resorting to speaking about “organization”. This is because I am very much minded to privilege the idea of people exchanging knowledge, connecting and conversing in an active and fluid context, that is to say, where people interact and organize together, rather than focusing on the organization, which – accepting this premise – is a reification of past organizing rather than the realization of current organizing between people. In short, the organization is the ossified remnant of past organizing, undertaken by the people seeking to work together – and so can act as a hindrance to the current organizing efforts of those individuals.

Three Learning Questions

So, the challenges represent a prism through which a practitioner might actively consider how best to explore helping people to organize together better, primarily through the notion of knowledge, connection and conversation. And it is important to reinforce the idea that this is a responsibility of everyone in an organizing context, whether they be performers, managers of performers, managers of managers, or specialists in the areas of improvement, development or effectiveness.

Hence, for everyone in the context, having a simple set of three questions means that they will feel better able to surrender the traditional notions of how people and organizations develop in favour of this more nuanced thinking in this regard. Those questions for me are as follows,

Learning Questions updated

 

This allows everyone in the organization to think about knowledge, connection and conversation from the personal perspective of their own practice (and, indeed, of the practice of those with whom they work or with whom they work alongside). Instead of the stilted appraisal conversation – in particular, the element where notionally people are asked to define their “learning needs” – these three questions are intrinsic to the work people do on a day to day basis – and seek to focus on practice rather than on “training” as the means of ensuring that knowledge flows through the organizing that people do and thereby makes that organizing more effective.

Ultimately, the more reflective supports that can be offered to encourage people to think of organizing rather than of organizations and to ensure that, within this vision, those seeking to organize find means to consider how best to let knowledge flow, connections form and conversations flourish, the more chance there will be for people to experience a richer organizational life and to enhance effectiveness in that context.

 

On power and pay packets

I recently completed a two-day accreditation for the Team Dialogue Indicator (TDI), a way in which teams can acknowledge, explore and improve the conversations that they have. As ever with such instruments, the art sits in the facilitation of a session where those team members get to converse about their conversations, off the back of their survey report.

I was much taken by TDI in that it was formed of six elements, one of which was power. This key aspect of organizational life is often neglected or, worse than that, willfully effaced to ensure that the work remains palatable in the complex contexts in which human beings find themselves at work. One often has to move into the somewhat arcane realm of critical management studies to find power acknowledged like this, so seeing it writ large in a team-based instrument was refreshing – and yet also challenging.

To be candid, I stowed away the challenge until I came across this little gem outside a pub called The Boot, which is on my route from Russell Square to King’s Cross Station…The Boot Happy Hour v1

Now, this is patently a jocular way of marketing the pub, which will appeal to many people. And yet, and yet… somewhere in there is the kernel of truth about the lived experience of people in this specific workplace that renders the remark comedic. It’s funny insofar as we know intrinsically what motivates the writer not least because it resonates, to a greater or lesser extent, with our own experiences.

So much current organizational development practice takes place where the idea of power is packaged up and cast outside of the discussions. We work as OD experts in a way that seeks staff engagement and a notional democratization of the workplace – and yet to pursue such an ambition without acknowledging the presence of power is to find ourselves practising in an ideological way.

Ultimately, the question is this: what would staff engagement look like if it was able to supplant and extent beyond the attitude to economic engagement in a capitalist economy that lies behind the comment on this board? Yes, it’s a joke: yes, it is designed to make us chuckle. But don’t we secretly know that a night on your feet on a busy bar, dealing throughout with a demanding public, is only motivating when it stops and you receive that pay packet.

How can you raise issues of engagement and involvement when, at root, it is the dull compulsion of the economic that drives people to the workplace on a daily basis? If you refute this somewhat harsh judgement – and there are myriad grounds so to do – my response is simple: how many of us deride those winners of hefty lottery payouts who publicly declare that they will not be giving up their daily work?

And before my interlocutor cries “ah-ha” and points out that such people are clearly motivated by more than money, in terms of what they derive from work, I raise two issues: first, I fear that it may be the case that such people are habituated into work and cannot imagine how their time would be spent without it. (My own father is something of a case in point here, but that is to generalize from the very particular, I concede.)

Second, and with a slightly less elitist tang to it, it is undeniable that work offers us comradeship, connection, banter, conversation, stories…as well as the vital pounds and pence. Yet, work is also a space where we are inscribed in power – and where, as a result, the very discussion of the notion of engagement for staff is suffused with power.

I am not even subscribing here to the notion of power as a broadly negative commodity, one that exists in a zero-sum relationship that means that, for someone to be in possession of it (so that they might instrumentalize it in some fashion), someone else needs to be denied access to it.

Indeed, I am taking power in this context to read as a productive element that courses through the warp and weft of our lives, the lives of others, and the connections that we all share. But this power crafts the human subject (usefully Althusser describes becoming a subject in the instant that a police office calls “Hey, you there!” at you across a street); it generates notions of normalcy and hence defines what we collectively then think of as the Other.

Where power used to feel hard – the graphic representations of the torture of the character of James Delaney in the recent BBC series called “Taboo” are illustrative in this regard – it is now softened and works through the capillaries of our daily lives to define and shape us, as a support to the wider fiction that we exist now in a liberal democratic context. Yet it remains power – and its presence and effect remain significant.

And so I come back to the idea of the way in which our work as OD practitioners might see us unwittingly subscribing to a fictional notion of engagement and such like, when workplace experience for many cannot be truly ameliorated and is determined largely (and doubtless in some cases exclusively) in terms of economic instrumentalism. On top of that is the wider question as to whether our role in this context is ideologised, in light of the fact that the very idea of engagement in the workplace is a fiction that we are actively promoting.

The work of Michel Foucault – whence a good deal of this thinking derives – is often seen as a counsel of despair. However, later writings by this philosopher intimate the capacity for human subjects to develop themselves in terms of their exploring their subjectivity through their interior world, using a range of personal activities such as journalising. This correlates with my belief in the centrality of reflection and conversation in organizational practice and affords an opening wherein it is possible to begin perhaps to visualize a new means of working in organizations.

 

From managing performance to maximizing potential

I ran a workshop session at the East of England Local Government Association annual coaching conference in Cambridge last Friday. It was a superb event, with a well balanced programme and an enthusiastic group of people in attendance.

I’m publishing my slides along with the notes from my session, which looked at the ways in which coaching can be used to adjust climate at team level and thence refresh and revise the management culture of an organization.

I began with an exercise to engage the room and start us thinking of the limitations that exist in our current approaches to work, the workplace and our workforces…

 

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In pairs, participants were asked to describe the next 90 days in terms of the organizational expectations of the teams in which they work…and to outline what they saw as their specific contribution to meeting those group expectations. The group was given ten minutes or so to consider this.

 

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In plenary, we explored how that changed focus – short rather than long timelines, collective rather than positional focus – felt.

The positive views expressed herein helped us to appreciate that work and the workplace are both very different now – and hence require a fresh and humanistic approach to motivating and managing people in each and every context.

From my perspective, I argue that there are six key issues in respect to this changed context that need to be acknowledged and incorporated into thinking about management in the 21st Century.

 

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PACE AND CHANGE IN THE MODERN WORKPLACE

Technological change and the globalized economy have led to a shift towards a 24/7 focus in terms of economic activity.

This increased velocity also speaks to a new level of complexity in human organizing and production, one where many of the challenges we face are “wicked problems”…and the very idea that we can plan and schedule for a medium- or long-term future seems even less plausible than it did when the age of certainty convinced us that leadership practice was simply a matter of intended cause and anticipated effect.

In the NHS, this is best exemplified by a cursory engagement in a simple PEST analysis…and a recognition that demand for services consistently increases by 4% p.a. and that technological and scientific advance is constant, in terms of activity and impact.

 

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DELIVERY THROUGH COLLECTIVE EFFORT

The notion of the heroic individual – the Stakhanovite who delivers their quota and then some, on the basis solely of their personal efforts – has always been a political rather than an authentically economic one.

That said, we continue to work with leadership concepts that are individualized and charismatic – whether in the Board room or the football ground – and many of our workplace practices (despite the discursive shift to a more collective orientation) continue to privilege the individual and not the team. For example, most management supervision takes place on a one to one basis and our approach to talent management, with its exclusive pools and cadres of high potential staff, underscore this.

Yet, in health care – and most human services – team effort is central to the delivery of safe and high quality care to patients and very little is exclusively about the singular efforts of one individual practitioner. But our HR processes (and attitudes) do not reflect this.

 

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PERSISTENCE OF SILO WORKING

In health and social care, the professional and occupational striations of our sectors have cross-hatched our organizational forms with negative impact in regards to connectivity and effectiveness.

This is as true within teams as between teams. The relatively insulated character of most people’s workplace practice makes team working more difficult than it needs to be.

 

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PSYCHOLOGY OF PERFORMANCE

There is a growing volume of persuasive material that underscores how our traditional views of performance and its maximization are faulty. This develops out of the shift to positive psychology – in particular to the development of the notion of “flow” – but is now apparent in Carol Dweck’s work on fixed and growth mindsets and David Rock’s discussions of the SCARF model, around Status, Certainty, Autonomy, Relatedness and Fairness.

Certainly, you might still get away with old ways of extracting work from people amongst workforces that are socially and economically marginalized – discussions around working conditions at the Sports Direct warehouse seem illustrative of this point – but it will certainly not help morale, productivity or discretionary effort.

 

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MAKING ENGAGEMENT MEANINGFUL

There is a vital distinction to be made between staff involvement and staff engagement. Many organizations imagine that working effectively alongside and through their workforce is merely a communicative initiative, delivered through “listening events”, town hall meetings and two way team briefings. That is important, of course, although we should never underestimate the ways in which people in an organization process activity like this.

Authentic staff engagement – often preached, rarely practised – touches a wide range of points in organizational life, from supportive leadership practice through levels of mutual team support, from meaningful autonomy through job crafting (or, at the very least, the opportunity to work as a fully-rounded person rather than as a “job description”).

In essence, we are talking about whether an organization sees its people as individuals – with all that those people bring through the door on a day to day basis – or whether they seem them as crudely categorized assets, crushed into broad professional, occupational or pay graded definitions.

 

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IMPORTANCE OF CONVERSATION

There is a school of thought that argues that organizations are constituted by the communication that takes place between their people.

Unfortunately, this view omits the significance of practice, process and procedure – but I am absolutely certain that meaningful and purposeful conversations between the widest range of people across an organization are the essential building blocks of effectiveness and continuous improvement.

 

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This is the new model for appraisal that is being trialled at the trust at which I was working before my secondment. It hinges on four quarterly coaching conversations between managers and their people, each of which works on a 90-day retrospective and forward look – but from the perspective of the deliverables for the whole team in that period. The conversation then opens up the space for the staff member to talk about the way in which they – as a member of that team – will contribute to ensuring that the expectations are properly met.

Each conversation is simply recorded as an exchange on a sheet of A3, divided into four quadrants, one for each quarter. This makes the process less bureaucratized, thereby allowing managers and their people to focus more on the discussions of achievements and contributions rather than the completion of reams and reams of paperwork.

The foundational basis of all of this requires us to ensure that all of our managers, firstly, understand and can apply the GROW model, insofar as it provides a simple and quickly absorbed means of shifting conversations from directional to supportive exchanges, and, secondly, have an acquaintance with situational leadership. The latter serves to provide a direction of travel for management practice across the organization alongside an appreciation that, in certain circumstances, a manager might need to move from a coaching approach to one that is more expressly managerial. This might include a situation where a member of staff isn’t delivering effectively to meet the expectations of the team, despite the coaching efforts of the manager, and so may now be subject to explorations of capability.

 

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Naturally, managers have sought further support, in terms of understanding this new approach and orientating themselves practically to its delivery. In particular, they wanted a steer as to what shape their hour-long conversation each quarter – referred to as a Progress Discussion – might take. In response to this, I generated the notion of A.E.I.O.U., which hopefully provided a quick and easy mnemonic as to how such as session might run without being too prescriptive.

 

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Behind that abbreviation, there lies three streams of advice: first, what the focus of each of the five phases of the discussion might be; the sorts of questions that a manager might use at each stage in order to support and encourage discussion; and what might be the outcome from each element of the conversation.

Importantly, this was about giving managers a framework within which their individual coaching practice could develop and evolve rather providing a fixed formula.

 

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Following on from this description of the pilot and to conclude the conference workshop, participants were asked to share with a pair a time in the past twelve months when their manager gave them truly positive feedback about something specific that they had done in their work…and how that had made them feel.

 

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We then explored the Positivity Ratio, with participants asked to cluster to four poles in the room in terms of whether they experienced this type of positive feedback from their manager in their working lives:
80-100% of the time
50-80% of the time
20-50% of the time
Less than 20% of the time

Interestingly, the group very helpfully threw up two important issues around this type of thinking that I had not considered to date. First, it was observed that it is important to build resilience and reflective capability in staff so that they can be confident in their own abilities and able to celebrate the excellence of their own work, without reference to someone in a supervisory system.Implicit in the remark was that some people are more than able to be self-sufficient in this regard and do not necessarily crave the approbation of managers.

This strikes me as true, although I’m also minded that positive feedback should be the lifeblood of a humane organization – and so everyone, managers and peers, should be equipped and encouraged to offer that supportiveness as an intrinsic part of their way of being in an organizational context. I also suspect – although this is perhaps a self-serving conjecture – that ensuring that managers are able to offer positive feedback will encourage uptake of the practice across the whole workforce.

Second, a participant suggested that the exercise could have been made richer by inviting those taking part to then allocate themselves against the four poles in the room in respect to the positive feedback that they would like to receive from their managers. This struck me immediately as a sensible way of enriching the exercise – so I advised the participant there and then that I intended to pilfer this exceptional suggestion!

This rich discussion curtailed the final element of this section of the workshop, which was to have been to encourage all in attendance to think about their supervisory or management practice and honestly assess the amount of time they spend in their discussions with their staff or teams in giving genuinely positive feedback – and whether that needed to reviewed and adjusted.

 

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In light of all of the above, it is apparent – of course – that the conversation needs to continue…and needs the widest range of voices and opinions in order to build upon it and construct a way of being in the workplace that supports the humanity of those with whom we work.

You are invited to use this space to add your own contribution to this discussion…and I thank you for that in advance.

 

Coaching, climate and culture

I was privileged to be part of an exceptional programme of speakers at yesterday’s CIPD conference on “Coaching for Business Performance”, where I showcased some of the work that has been going on at climate level in order to move from a directive to a supportive management culture. Here are some of the slides and the ideas that I outlined at the event, as I explored changes in appraisal practice as a key prompt in this regard.

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Motivation comes pretty much in one of two forms: the first is represented here – if a hungry bear is on your tail, it’s certainly an incentive to pedal as fast as you can. But if this happened every day – you know you have to cycle this route and at some point on the route this angry bear is going to come tearing after you – its going to take it out of you, both physically and mentally.

The alternative is the motivation that comes from a supportive team and a manager who works with you to get the best from you – and the rest of their team – and who offers positive, appropriate and meaningful feedback on what you do at work.

 

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For the longest time, we have worked on the tired assumption that motivation is delivered through things like performance appraisal, which increasingly looks like the bear charging out of the woods to snap and swipe at the hind quarters of us poor souls trying to make our way effectively and creatively in the workplace. And, if it isn’t experienced as a bear chasing us, it can feel like a shallow and meaningless ritual. Either way, of course, it offers nothing in the way of motivation, unless your manager is equipped with well-developed and meaningful people skills that mean that you are regularly getting feedback on performance, of which the annual appraisal is merely one small segment.

 

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So, here is an assembly of some of the materials that have appeared in recent years that describe a different way of motivating people in the workplace – and provide the foundations that indicate why this more positive and supportive approach to managing is more effective in that regard. And this sort of material – including neuroscientific work and psychological notions, such as can be found in Dweck’s work on mindset – shaped my thinking as to how appraisal might be done differently as a means of supporting a wider shift in management approach.

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You will be familiar with the entirely fictional figure that 70% of change initiatives in organizations fail. This reason that this particular canard has gained ground is doubtless that it seems to resonate with our experiences as people in the workplace. So, intuitively we know that it is better to light 100 fires, fan those that look set to generate the most heat and warmth, and let others go out of their own accord.

At C&I, in light of the literature, one fire that we have lit and are actively fanning is this move towards a coaching approach to appraisal, with a clear sense that, if we can encourage managers to use coaching techniques in this element of their practice, it will seep into their wider repertoire of management and engender a wider cultural shift – all the time offering positive motivation to our workforce and improving their experience and their performance.

This is the model we have adopted in the pilot that is running this year – managers have a quarterly progress discussion with all of their direct reports and make the briefest report on the outcomes of that discussion on an A3 template that is divided into four.

Our focus has been on supporting managers with the skills associated with using the GROW model and questioning techniques; we’ve also ensured an awareness of situational leadership, in order that those managers understand the trajectory but also appreciate the need in some specific situations to move from a coaching to a more directive style, either in respect to capability or in regard to the need for someone to take charge in an emergency circumstance.

These discussions dispense with the standard “management by objectives” (MBO) approach, which in a complex setting where change is a constant feature and where most of our deliverables are realized through the successful collaboration of teams is entirely unsuitable, in favour of asking managers to horizon scan on behalf of their teams for the next 90 days in order to isolate and articulate the challenges for those teams in that period – and so to be better able to discuss with all teams members what their contribution is going to be to meeting those expectations.

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In terms of running these hour long Progress Discussions, we have suggested managers use this AEIOU model of managing the trajectory of their conversations, embedding GROW within the narrative arc of these discussions…

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…and here’s that model in a little more detail, outlining the focus of each stage of the conversation alongside some suggested questions and an indication of what the likely outcome of each element might be. Importantly, this is a prompt for a supportive conversation and an indicative rather than a prescriptive device, in terms of providing a guide to managers.

In terms of evaluation, we are naturally using a number of proxy measures, not least the staff engagement score in the annual staff survey and the questions therein that focus in particular on the quality and usefulness of appraisal to the staff member. Alongside this, we intend to evaluate thoroughly at the end of the pilot – but we are also collecting and collating qualitative feedback that is channeled back to the team via the liaison member of staff attached to each pilot area.

Thus far, that feedback reveals the following themes in terms of the new approach…

Offers a space to discuss and reflect

The whole thing feels more relaxed and engaging

Better focus on the conversation not the paperwork

Staff are showing a greater willingness therein to generate solutions to issues faced by teams

It has changed conversations in practice in general

However…

Managers crave more information – and more support around technique, e.g. the application of GROW

Some staff have struggled to feel inspired enough to engage

It feels slightly more daunting for the manager due to being less structured.

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Ultimately, all of this work leads to a recognition – reinforced by the inquiry work that we recently undertook prior to thinking in practice about what shape to give our OD strategy – that underpinning all successful efforts around organizational effectiveness, performance improvement, and staff satisfaction is the interplay between three things, which – in their triumvirate form – provide steerage for any work that goes on in this area.

These are: conversation; action; and reflection – and, although their sequencing is far from fixed (it is not necessary to create a schema where one of necessity follows another follows another), their interrelatedness is unbreakable and can – through techniques such as After Action Review, a technique that hinges on the conversational application in a practice setting of four questions – sequence entirely differently, yet remain intimately and unshakably connected.

Importantly – in light of the way in which organizations privilege the notion of “doing” in contrast to “conversing” or (perhaps even less respected in our busy workplaces) “thinking” – the importance of taking time to reflect after a discussion and prior to action can equally well be advocated.

To conclude, then, this work is vital in and of itself – it addresses the need for better staff engagement and offers an entirely new and more modern approach to performance management. But, in reality, this climatological shift in grassroots management practice also is primed to have the effect outlined below, namely that it builds to create a wider cultural shift in the organization…a shift that could not realistically be delivered through a top-down, forcefully implemented “culture change” programme.

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The old is dying and the new cannot be born

This remark about a specific political impasse comes from the Italian Marxist Antonio Gramsci. It appeared recently in a newspaper piece about Britain’s vote to withdraw from the EU but it immediately struck me – as I surveyed the situation in respect to health and social care in this country – that it could apply equally well to the circumstances faced by the National Health Service.

The news media is filled day after day with stories of the NHS failing to deliver on its 68 year old promise to offer quality care free at the point of need; the latest today focused on a patient left dead and unnoticed for four and a half hours in an Emergency Department.

Quite simply, the NHS cannot meet the constantly growing expectations of its customers – or, indeed, their developing and increasingly complex needs. And yet two things are abundantly clear: first, that there will be no additional funding, because that is economically unacceptable in light of the current circumstances – and it remains moot as to whether additional funds would actually help at this time. The fiscal crisis of the state, a Marxian term that speaks to the disequilibrium that exists when welfare states see their revenues collapse and demand increase during times of economic crisis first coined by James O’Connor, seems to have even greater resonance in our contemporary setting.

Second, it is apparent that there will be no political intervention to manage demand, through rationing or levy of additional charged, because that is deemed electorally unacceptable. All that is left is the idea of unleashing innovation and improved efficiency within the NHS, something that remains elusive for a range of reasons.

In the policy paralysis that this engenders, the deficit across the NHS will continue climbing and staff will continue to struggle to deliver the sort of service that they professionally aspire to offer. Patients will almost certainly suffer, as they have done to date. And voices hostile to the very notion of socialized medicine will begin to fill the space that is opening up, which will leave NHS supporters reacting to radical and unpalatable ideas rather than coming up with their own sympathetic solutions.

The NHS workforce consists of 50.6% professionally qualified staff. One would presuppose that amongst such a group there would be myriad ideas and a rich source of creativity. Certainly, that may be the case. However, recent research suggests that innovators and “intrapreneurs” are compelled to struggle out from of the strictures and risk-averse culture of the NHS to explore and deliver on those creative ideas. It means that much innovation springs up in liminal spaces in relation to the NHS – but that the NHS then engages with those developments, often commissioning service from them.

This resonates with the platform economy, where companies such as AirB&B and Uber, lacking specific assets themselves, merely provide a commercial location that connects a buyer with a seller, whether that be a homeowner or a car driver. Certainly, this model is not without its drawbacks: quality assurance has been raised as an issue and the flexible nature of the “workforce” in the case of Uber has been in the spotlight. Nevertheless, the notion of a transaction platform, linking health care consumers with providers (in the widest definition) whilst maintaining a commitment to open access to care at the point of need, has its attractions. It should be noted that those providers might be innovators from the professions, developing companies to offer a specific clinical service; accountable care organisations (as they develop), and – yes, I have to say it – private providers, if they are best placed to meet population needs.

There is an imperative that these debates be raised now, so that meaningful exchanges can take place to explore the best way of meeting the health and social care needs of a population. And it is an unpalatable truth that the NHS model of today – still bearing the imprints of its post-war provenance and the patina of its political history – simply cannot deliver what is needed within the financial envelope. A whole range of other delivery models – including an exploration of the platform economy approach – needs to be considered.

Equally, there is a pressing need for the politicians and other policy makers to reshape the expectations of those populations in terms of health care. Without an hypothecated tax to support health and social care, it will be impossible to keep abreast of the constantly climbing cost of providing the NHS…and, even then, it is unclear as to whether any amount of funding can offer the sort of limitless provision that is generally expected. Demand needs to be dampened – through education and, yes, quite likely through the introduction of further charging, such as we have seen since early in the service’s existence with dental, optical and prescription services -and it needs to be channeled, in terms of reducing the overuse of the service and encouraging greater personal responsibility for personal health and well-being.

Lastly, there is an urgent need for the NHS to find a way to unleash the talents of all of its staff, in terms of not just caring for patients – that is, seeing us on a one to one basis to diagnose and treat – but also for caring about patients, in terms of thinking differently and systemically about their ways of working in order to make the service more efficient for the user – and cost effective for us all.

In many instances when thinking about this, people end up talking about unleashing creativity or encouraging innovation. Such terms can represent a hard sell to a workforce, for a range of reasons. In reality, all the service needs is for everybody who works in it to show some imagination – and, alongside that, some determination to follow through and improve the way things happen in the NHS. Contextually, this needs managers in the service – from trust CEOs through the regulators to NHS England and the Secretary of State – to grant licence to their staff to think anew about how they practice – and design new ways of doing it.

In medical terms, this piece is not a prescription, far from it. It is a suggestion as to how we might change our behaviours in order to sustain the NHS on which countless people rely. Others in the family of those who have an allegiance to the service will have a different take on models that we might use – and these need to be articulated, explored and evaluated. It’s a tiny contribution to what needs to be a wide ranging and involving conversation. Without it – as mentioned earlier – others who feel less of an allegiance to socialized medicine will shape a debate in which each and every one of us has a stake…and inadvertently through our abstinence we will end up losing the very heart of what makes health care in this country so special and so respected.

 

 

Developing middle managers as culture change agents

Slide1

I was delighted recently to be able to present a case study at the CIPD Learning & Development Show in London. This provided me with the opportunity to share some thoughts and discuss some activity around supporting an organisation to make a cultural shift. I am pleased to offer the slide deck and the notes for the talk here.

 

Slide2

I wanted to begin with some preliminary observations and scene setting that explains my core thinking in this regard and I felt that this image provided a useful prompt to support the discussion of four points.

To me, the path signifies…

1.The way in which our managers in the NHS drift into management, having had a successful clinical career.

2.A myth of management, which is that its practice is merely a succession of technical decision points, amenable to reason and built on the notion of cause and effect. The reality is infinitely more complex and far less certain than that.

3.A myth of leadership, which is that we can choose a path – a strategic direction, a commitment to a culture change exercise – and point heroically in that direction, so that people merely follow up and pass through a series of milestone. This illusion is a worrying one, as it creates a certainly around agency that has no grounding in reality – and so sets the scene for poor practice amongst leaders.

4.The need to develop map-makers not map-readers…and those who carve their own paths in order to progress towards their aims.

This sets the scene, I hope, for a conversation about how best to support cultural change in organisations.

 

Slide3

Critically, I want to throw into question the cause and effect notion of culture change. Quite simply, large scale culture change programmes are problematic, largely ineffective, and ultimately somewhat sinister. Forcibly acculturating people is a nigh on impossible task: human beings have agency and any attempt to impose culture is vaguely totalitarian, will lead to resistance, and ultimately will never truly stick. More than anything else, that human agency means that it’s pretty much certain never to go to plan.

But, of course, we do expect organisations to change and develop in this regard; the question is “How?”

 

Slide4

To move your culture entails affecting organisational climate – and that means involving all of the workforce in making changes that precede behavioural alterations that then beget a cultural shift…and this is a long and slow process, regardless of what the change literature might suggest. In our experience, the key group in mobilising this kind of practical change is middle managers.

Of course, they are the group, according to Barry Oshry’s work, that are most susceptible to “tearing”, that is, being suspended between the needs of the top team and overseeing effective delivery at a local level. And they can sometimes end up as the inflexible mouthpiece of the senior leadership or merely advocating on behalf of their staff.

They need to be fostered, developed – and prepared for the particular challenges of middle management, which is something that we have endeavoured to begin to do.

 

Slide5

We have sought to BUILD SKILLS amongst our managers by offering interventions in terms of programmes of management and leadership development, all of which pivot around the notion of learning in and through practice. We initially privileged management practice, as this is the solid underpinning of sensible leadership. Latterly, we have expanded into offering interventions that are focused on leadership as a behaviour rather than merely as a status – and which seeks to build on surfacing innate leadership capabilities that all individuals possess rather than grafting “leadership” onto individuals in a somewhat forced and artificial fashion.

 

Slide6

Alongside this, we have endeavoured to ENHANCE PRACTICE of managers through our DEVELOPING OUR PEOPLE initiative, which consists of two streams: a radical departure from traditional performance appraisal to an approach based on quarterly coaching conversations; and a genuinely fit for purpose talent identification and development model, one which sees the whole workforce as talent rather than a select pool of people and which, in league with this, focuses on individual aspirations rather than managerially defined potential. We have worked to support managers to make that shift…and are seeking to amplify, wherever we can, the positive ramifications that will exist across the organisation if that transition is successful.

 

Slide7

Lastly, we have opted to EXTEND THE REACH of our management practice, through the development of OD and Staff Engagement strategies that actively sought to precede their drafting with genuine conversations across the organisation, ensuring that this acts as a model for management – so that conversation and involvement are key to being a manager in our organization.

 

Slide8

We have worked to build skills, enhance practice and extend reach in terms of our management and leadership practice in order to affect changes in organisational climate across the various components of the organisation – right the way down to the critical level of the team, of course – so that the aggregated effect of these climatological shifts is to nudge our overall culture in the direction where management in the trust is seen to be empowering, driven by coaching technique and geared towards offering positive and effective feedback…

 

Slide9

…and where the managers themselves are more receptive to conversation and feedback – and feel less need to be controlling. We take this view because of the vital need for all NHS organisations to unleash the talent of their workforces, wherein resides the vital intelligence and potential for “intrapreneurship” that will support the service during this crucial time in its history.

 

Slide10